Device and method for isolating a surface of a beating heart during surgery

ABSTRACT

Disclosed is a device for isolating a cardiac surgical site. The device comprises a first finger having a clinging accessory for attaching the first finger to a heart, a second finger having a clinging accessory for attaching the second finger to the heart, a first joint disposed on the first finger so that the first finger may rotate on a surface of the heart such that said rotation stretches a surgical site, a first stopper disposed on the first finger for preventing undesired rotation of the first finger to isolate the surgical site, and a link for coupling the first finger to the second finger. Several embodiments of the fingers and clinging accessories are disclosed. A guard is provided to protect sutures from the clinging accessory. The guard is equipped with a sprayer to wash the surgical site. Also disclosed is a method of isolating a cardiac surgical site. The method comprises the steps of disposing a first finder on a heart, clinging the first finger to the heart surface, disposing a second finger on a heart, clinging the second finger to the heart surface, and then rotating the first finger for achieving selective isolation of the heart surface.

CROSS REFERENCE

This application is a continuation of U.S. Ser. No. 09/632,430 filed onAug. 4, 2000 which is a continuation in part of U.S. Ser. No. 09/376,538filed Aug. 18, 1999, U.S. Pat. No. 6,258,023 which claims the benefit ofU.S. Provisional application Serial No. 60/143,023, filed Jul. 8, 1999,the disclosures of which are hereby incorporated by reference.

FIELD OF THE INVENTION

The invention relates generally to medical surgical devices, and moreparticularly to a device and method of stabilizing a surgical siteduring cardiac or cardiovascular surgery.

BACKGROUND OF THE INVENTION

Heart disease and associated cardiovascular problems have become socommon in the United States that over 400,000 open heart surgeries areperformed each year. Traditionally, physicians would open the chest andstop the heart before performing a surgical procedure on the heart.However, medical practices have improved, and physicians now recognizethat there are advantages to performing surgery on a beating heart. Forexample, performing surgery on a beating heart avoids the necessity toexpose the heart to filters, oxygenators, tubes, and other devices. Thisdecreases the trauma associated with stopping the heart, as well asavoids other dangers that stopping the heart poses to a patient. Inaddition, by avoiding the use of these devices, the physician can lowerthe expense of an operation. Furthermore, performing surgery on abeating heart lowers the risk of ischemic damage to heart andsurrounding tissue.

Unfortunately, there are many difficulties and challenges which must beovercome to successfully perform surgery on a beating heart. Forexample, every time the heart beats, the heart moves. This makes itdifficult to isolate a specific site on the heart for surgery.Furthermore, physicians typically must develop great skill and expertiseto accommodate the movement of the heart with existing instruments whichwere designed for use with a heart that is stopped. Because of theincreased demands of performing surgery on a beating heart, surgery on abeating heart often takes longer than surgery on a stopped heart.Fortunately, devices and methods are being developed which decrease theamount of time and expertise it takes to identify and isolate a targetvessel and thus, reduce the time it takes to perform open heart surgery.

One family of instruments which have been developed to facilitatesurgery on a beating heart are known as cardiac immobilization devicesor heart stabilizers (devices). A number of these devices function byattaching to the heart at two or more points. The points are then movedfurther apart, thus stretching the surface area of the heart about whichsurgery is to be performed (surgical site). The devices typically gripthe heart surface by suction. Unfortunately, there are a number ofdisadvantages associated with these methods of isolating a surgicalsite.

Some cardiac immobilization devices often appear to be little more thansteak tongs or clamps which have been slightly altered to attach to aheart surface. Other devices use flex links or rods to attach to aretractor and then use a metallic foot to stabilize the heart surface.Suction devices may comprise a plurality of suction cups, or may have atleast one hollow cylinder with holes in it, which is then attached to apump which pulls a vacuum at the holes.

FIG. 1A (prior art) shows a cardiac immobilization device 130 attachedto a heart surface 140. To perform open heart surgery, typically a chestretractor 110 is braced within a rib cage and used to maintain anopening in the chest wall 112 which provides access to the heart surface140. A stabilizing member, such as a flexible arm assembly 120 is usedto securely locate a cardiac immobilization device 130 upon the heartsurface 140. Accordingly, the stabilizing member 120 is coupled to theretractor 110 via a clamp 126 and holds the cardiac immobilizationdevice 130 in a predetermined position.

The flexible arm assembly 120 includes a flexible arm 124 which may bebent and twisted into various shapes and geometries to access differentlocations on the heart surface 140. At the end of the flexible arm 124closest to the heart surface 140 is a socket 128 for attaching theflexible arm 124 to the cardiac immobilization device 130. At the otherend of the flexible arm 124 is a handle 122 which when turned tightens acable (not shown) within the flexible arm 124. The tightening of thecable makes the flexible arm 124 rigid and immobile. The tightening ofthe cable also tightens the socket 128, allowing the socket 128 to gripan object, such as a ball 132 (the ball 132 is part of the cardiacimmobilization device 130).

The shown cardiac immobilization device 130 uses suction to attach to asurface of the heart 140. To attach the cardiac immobilization device130 to the heart surface 140, the cardiac immobilization device 130utilizes a foot plate 136 with holes thereunder (not shown) on which avacuum is placed. The vacuum is maintained by air hoses 134 which areattached to an air pump (not shown) and the foot plate 136. Thus, thecardiac immobilization device 130 is held stationary on the heartsurface 140 at the end of the flexible arm 124 of the flexible armassembly 120 so that the heart surface 140 located within the foot plate136 can be isolated.

One disadvantage of many tong type attachments is that they provide anuneven spread (the heart surface closest to the tong's hinge point isspread a smaller distance than the heart surface at the end of thetong).

There are also many disadvantages associated with using suction toisolate a surgical site. For example, many patients have a heart whichis surrounded with fatty tissue. Since the fat surrounding the heartmoves, when a physician uses a suction device to isolate a heartsurface, the suction cups or suction holes attach to the fat (ratherthan the heart surface). The operative result of the device attaching tothe fatty tissue is that the heart surface can still beat underneath thefatty tissue, which means that isolation and stabilization of thesurgical site is poor. Furthermore, the fatty tissue may be drawn intothe device (at a hole, for example) by the suction, and may clog thesuction device thereby stopping suction at the holes which are furtheralong and at the end of the device. In addition, after attachment to theheart is made with a suction device, the ability to spread the heartsurface is limited by the force of suction on the heart surface. Shouldthe suction break, the device must be repositioned and reattached to theheart, which consumes time and is a nuisance to the physician.Furthermore, when strong enough suction is applied to the heart surfaceto achieve adequate spreading and to prevent slippage, the suction cancause blood to accumulate and clot just beneath the heart surface, ahematoma (this condition is also commonly referred to as a “hearthickie”).

Therefore, what is needed is a device and method of isolating a surgicalsite for cardiac and cardiovascular surgery. The device should contact aminimal surface of the heart, accommodate the non-planar geometry of theheart, grip the heart firmly, yet gently, and should be easy to apply toand to remove from a beating heart.

Blood in arteries can spew out from the anastomosis site during surgery,which reduces visualization for the surgeon. Periodically, blood must bemanually removed by an assistant typically with a blower. The surgeon,therefore, must stop the procedure so that blood can be removed. What isneeded, therefore, is a stabilization device integral with a blowerdevice so that the blower could be operated remotely without interferingwith the procedure.

SUMMARY OF THE INVENTION

A device and method is provided for isolating a heart surface,particularly, the surface of a beating heart during cardiovascularsurgery. The device utilizes rotation to attach to the heart surface andthen spread the heart which isolates the spread portion of the heart forsurgery.

Disclosed is a device for isolating a cardiac surgical site. The devicegenerally comprises a first finger (which may be cylindrical) having aclinging accessory for attaching the first finger to a heart.Furthermore the device could comprise a second finger having a clingingaccessory for attaching the second finger to the heart, a first jointdisposed on the first finger so that the first finger may rotate on asurface of the heart such that said rotation stretches a surgical site,and a link for attaching the first finger to the second finger. Inaddition, a first stopper may be disposed on the first finger forpreventing undesired rotation of the first finger to isolate thesurgical site.

The accessory for attaching could comprise a plurality of tines, aplurality of suction points, or a rough textured surface such as asurface similar to sandpaper, for example. In addition, the first jointor a second joint (disposed on the second finger) could comprise arotatable handle coupled in a sleeve. Furthermore, the first stopper ora second stopper (disposed on the second finger) could be configuredsuch that the rotatable handle comprises at least one notch and thesleeve has at least one rib. Likewise, the first stopper or the secondstopper (disposed on the second finger) could be configured such thatthe rotatable handle comprises at least one rib and the sleeve has atleast one notch. The handle could comprise an O-ring groove for securingan O-ring about an end of the handle.

The link could comprise a ball and socket joint disposed between thefirst finger and the second finger for providing multi-axis articulationof the first finger and the second finger, as well as a first attachmentbar coupled between the first handle and the ball and socket joint, anda second attachment bar coupled between the second handle and the balland socket joint. Conversely, the link could comprise a first ball andsocket joint associated with the first handle, a second ball and socketjoint associated with the second handle, and an attachment bar forcoupling the first ball and socket joint to the second ball and socketjoint.

More generally, the present invention provides a means is provided forisolating a cardiac surgical site. The means for isolating comprises afirst support means, such as a finger or a functional equivalent, havinga clinging means for attaching the first support means to a heart, and asecond support means, such as a second finger or a functionalequivalent, having a clinging means for attaching the second supportmeans to the heart. The means for isolating also includes a rotatingmeans, such as a cylinder or a functional equivalent, disposed on thefirst support means so that the first support means may rotate on asurface of the heart, a locking means, such as a rib and notch, or afunctional equivalent, disposed on the first support means forpreventing undesired rotation of the first support means. An attachingmeans, such as a link or a functional equivalent, connects the firstsupport means to the second support means.

There is also provided a shield or guard attached to the fingers so theclinging means will not catch sutures, gloves or tissues during themedical procedure. The shield may also have a sprayer for washing thesurgical site.

In another embodiment, a method of isolating a cardiac surgical site isprovided. The method comprises disposing a first finger on a heart,clinging the first finger to the heart surface, disposing a secondfinger on a heart, clinging the second finger to the heart surface, androtating the first finger for achieving selective isolation of cardiactissue. The method may further comprise rotating the second finger,locking the first finger to prevent rotation, or locking the secondfinger to prevent rotation. The method may also provide that clingingcomprises penetrating the surface of the heart, applying suction to thesurface of the heart, or applying an abrasive surface for frictionallygripping the surface of the heart. In addition, when applying a finger,the method may further comprise the step of compressing the finger ontothe heart surface. Furthermore, the method could include the step ofelevating the finger while maintaining its attachment to the heartsurface.

The rotational action allows the physician to overcome problemsassociated with fatty tissue on the heart surface, to adjust the spreadof the heart surface during surgery, and to attach and detach from theheart quickly.

BRIEF DESCRIPTION OF THE DRAWINGS

Other aspects of the invention, including specific embodiments, areunderstood by reference to the following detailed description taken inconjunction with the drawings in which:

FIG. 1A (prior art) shows a cardiac immobilization device attached to aheart surface;

FIG. 1 is an isometric view of one embodiment of a device;

FIG. 2 shows a side view of the device shown in FIG. 1;

FIG. 3 is an exploded view of one arm of the device of FIG. 1;

FIG. 4 is a front view of the finger having tines attached to the holes;

FIG. 5 is a cut rear view of the handle taken along line 5—5 of FIG. 3;

FIG. 6 shows the sleeve in greater detail;

FIG. 7 is a cut side view of an arm in a locking position where thelocking position is defined as the position of the device when the ribis set in a notch;

FIG. 8 illustrates the sleeve relative to the handle when the device isin a rotatable position;

FIG. 9 is a flow diagram of one method;

FIG. 10 is an isometric drawing of the present invention which includesa flexible arm assembly;

FIG. 11 is a side view of another embodiment;

FIG. 11b is an isometric drawing of the embodiment shown in FIG. 11a;

FIG. 11c is a front view of the embodiment shown in FIG. 11a;

FIG. 12a is a side view of another embodiment;

FIG. 12b is an isometric drawing of the embodiment shown in FIG. 12a;

FIG. 13a is a side view of another embodiment;

FIG. 13b is a portion of a front view of the embodiment shown in FIG.13a;

FIG. 14a is a side view of another embodiment;

FIG. 14b is an exploded view of FIG. 14a;

FIG. 14c is a section view of the embodiment shown in FIG. 14a;

FIG. 14d is a section view of the embodiment shown in FIG. 14a adjacentto the surface of a heart;

FIG. 15a is a front view of the fingers 10 and 12 (FIG. 2) with anotherembodiment of a clinging accessory;

FIG. 15b is a front view of the device shown in FIG. 2 with anotherembodiment of a clinging accessory;

FIG. 15c is a front view of the device shown in FIG. 2 with anotherembodiment of a clinging accessory;

FIG. 15d is a front view of the device shown in FIG. 2 with anotherembodiment of a clinging accessory;

FIG. 15e is a front view of the device shown in FIG. 2 with anotherembodiment of a clinging accessory;

FIG. 16a is an isometric drawing of one embodiment of the presentinvention;

FIG. 16b is an exploded isometric view of FIG. 16a;

FIG. 16c is another isometric drawing of the embodiment shown in FIG.16a;

FIG. 16d is an exploded isometric view of FIG. 16a;

FIG. 17a is an isometric drawing of another embodiment; and

FIG. 17b is a combination top view and schematic view of anotherembodiment present invention.

References in the detailed description correspond to like references inthe figures unless otherwise indicated.

DETAILED DESCRIPTION

The present invention provides devices and methods for isolating a heartsurface, and particularly the surface of a beating heart, duringcardiovascular surgery. The device attaches to the heart surface andthen utilizes rotation to spread the heart and isolate the spreadportion of the heart (surgical site) for surgery. The rotational actionallows the physician to overcome problems associated with fatty tissueon the heart surface to adjust the spread of and tension on the surgicalsite during surgery, and to attach and detach the device from the heartquickly. Other advantages and uses of the present invention will beapparent to those of ordinary skill in the art from the followingdescription of the drawings.

FIG. 1 is an isometric view of one embodiment of a device. The devicegenerally comprises a pair of stainless steel fingers 10, 12 which aremounted in stainless steel handles 14, 16. Of course, the fingers 10, 12and the handles 14, 16 may be made of any other material, such asplastics, rubber, other metals, or composite materials, for example.Furthermore, the fingers 10, 12 and the handles 14, 16 could be formed,cut or molded as a single unit. Stainless steel sleeves 20, 22 fit overthe handles 14, 16 and are held in place about the handles 14, 16 byresilient O-rings 24, 26. Of course, sleeves 20, 22 could be made out ofany material, including plastic, nylon, or rubber. The combination of afinger, a handle, a sleeve, and an O-ring is called an “arm.” To coupletwo arms together, the sleeves, 20, 22 are attached together by a link18 which is shown in FIG. 1 as a ball and socket assembly, for examplethe combination of both arms and link 18 is known as a finger assembly36.

A link is any device or collection of devices used to associate a fingerand a stabilization device, such as another finger. The link 18 of FIG.1 comprises a stainless steel ball 17, which is weldedly coupled to eachsleeve 20, 22 by stainless steel attachment bars 19. The ball 17 issecurely fastened in a socket 128 of the flexible arm assembly 120 shownin FIG. 1a. Of course, other link devices may be used. For example, thelink 18 could comprise an attachment bar alone. Furthermore, ball 17could be made out of plastic or nylon and molded as a single unit toattachment bars 19. Likewise, stabilizing members may have a variety ofdesigns, and these other designs may use other types of mechanical linksto maintain a predetermined distance between the fingers.

FIG. 2 shows a side view of the device illustrated in FIG. 1. Finger 10has a plurality of tines 30 which function as a clinging accessory toattach the device to a heart surface. Accordingly, a clinging accessoryprovides a finger traction to a heart surface. Other clingingaccessories (such as suction holes, suction cups, rough texturedsurfaces (such as sandpaper), barbs, or electrostatic attachment, forexample) are well known in the art and may be adapted for use. Also, thehandle 14 has a knob 42 which extends higher than the sleeve 20 so thatthe physician may grasp and rotate the handle 14. The sleeve 20 has aplurality of notches 50, and the handle 14 has a rib 40 which fitssecurely inside of one notch 50. Accordingly, the combination of the rib40 and a notch 50 together form a stopper which may be set to preventrotation of the fingers 10, 12 as discussed below. A betterunderstanding of the form and function may be gained by examining thedevices' individual components and their interrelations.

FIG. 3 is an exploded view of one arm of the device of FIG. 1. In FIG.3, the finger 10 is seen to possess a plurality of holes 32 which acceptthe tines 30. Although five holes 32 and five tines 30 are shown in FIG.3, it should be understood that the finger 10 may have any number ofholes 32 and a corresponding number of tines 30. The holes 32 are ofsufficient depth so that the tines 30 may be attached therein withsolder, glue or by other means. Although the finger 10 of FIG. 3 isshown to be cylindrical, it should be understood that a finger may haveany geometry so long as it may attach to a heart surface and stretch asurgical site by rotating. Finger 10 also has an attachable portion 34which fits securely in a cylinder 44 of the handle 14.

The handle 14 has a grippable knob 42 which is capable of being securelygrasped and turned. Abutting the grippable knob 42 is the rib 40. At theother end of the handle 14 is a groove 48 which functions as an O-ringseat. The end of the handle 14 having the groove 48 is preferably shapedlike a hemisphere to facilitate placing the O-ring 24 onto the groove48.

FIG. 4 is a front view of the finger 10 having tines 30 attached andholes 32. From FIG. 4 it is seen that the tines 30 have a hook shapewhich minimizes heart surface penetration and which facilitates therelease of the tines from the heart muscle. The tines are of a stiffnessso that should a stretching rotation require the releasing of the tinesfrom the heart surface, they may release without ripping the heartsurface, and then re-penetrate the heart surface at a new location, ifnecessary. Also, it should be noted that the tines point generally inthe direction of the grabbing rotation. Although four linear rows areshown in FIG. 4, the invention may have any number of rows which mayinclude non-linear, or even apparently random, row formations. In oneembodiment, the tines have a length of about one quarter inch. Ofcourse, other methods of attachment are well known in the art. Theseinclude but are not limited to, rough textured surfaces such assandpaper, barbs, electro-statics, and suction holes, for example.

FIG. 5 is a cut rear view of the handle 14 taken along line 5—5 of FIG.3.

From this view it can be seen that the grippable knob 42 extends bothabove and below the cylinder 44. The portion of the grippable knob 42extending below the cylinder 44 forms a lip 46 which is of a width thatmatches the circumference of the sleeve 20 such that when the sleeve 20fits over the cylinder 44 the outside of the lip 46 aligns with theoutside of the sleeve 20. This view also illustrates that the rib 40 isof a width and size to accommodate the notch 50.

FIG. 6 shows the sleeve 20 in greater detail. As shown, sleeve 20 has aplurality of notches 50. Although four notches are shown in FIG. 6, thesleeve 20 may have any number of notches 50 so that the rotation of thefingers may be held at varying degrees of rotation. In addition, oneside of the sleeve 20 has a hole 54, or other surface preparation, foraccepting the attachment bar 19 (of course, the sleeve 20 may have otherapertures attached to it depending on the link 18 used; likewise, thesleeve 20 may be connected to a link via welding, which avoids the needfor apertures or modifications). The O-ring 24 pushes against the handle14 so as to apply tension to the sleeve 20 to securely force a rib 40over notch 50, as described below. Accordingly, the sleeve 20 has acylinder 56 which at the end opposite the notches 50 has a tapered lip52 which is shaped to accept the O-ring 24 to minimize wear on theO-ring 24.

FIG. 7 is a cut side view of an arm in a locking position where thelocking position is defined as the position of the device when the rib40 is set in a notch 50. Also, when in the locking position, the sleeve20 fits securely against the handle 14. In the locking position, theO-ring 24 in groove 48 exerts a force upon the sleeve 20 to keep it inplace abutting the handle 14. Furthermore, note that the rib 40 alsoabuts the sleeve 20, indicating that a notch 50 (not shown) is inposition about the rib 40, forming a stopper.

FIG. 8 illustrates the sleeve 20 relative to the handle 14 when thedevice is in a rotatable position. Here, it can be seen that the sleeve20 is pushed against the O-ring 24, causing distortion of the O-ring 24.The separation of the sleeve 20 from the grippable knob 42 removes thenotch 50 from the rib 40 and allows for the handle 14 to be rotated.Accordingly, as the handle 14 rotates so does the finger 10. Then,depending on the direction of the rotation, the heart surface willeither be stretched or compressed. A three dimensional drawing of thepresent invention is illustrated in FIG. 10 in which finger assembly 36(FIG. 1) is mounted on a flexible arm assembly 190. Flexible armassembly 190 includes a flex arm 191 which may be bent and twisted intovarious shapes to access different locations on the heart surface.Socket 192 is on one end of flexible arm 191. Socket 192 has a sphericalvoid (not shown) which allows it to mate with ball 17 (FIG. 1). At theother end of flex arm 191 is universal retractor mounting 194 andvariable tension lock 195. Universal retractor mounting 194 mounts tochest retractor 110 (FIG. 1a). Variable tension lock 195 tightens acable (not shown) within flex arm 191. This tightening causes flexiblearm 191 to become rigid and immobile, and thus allows fingers 10 and 12remain placed against the heart after placement.

One method of implementation uses the above disclosed device.Accordingly, FIG. 9 is a flow diagram of one embodiment of a methodFirst, the chest cavity is cut and opened and held securely in place,typically by a chest retractor, in an expose heart and place retractorstep 90. As advances in open heart surgery are made, less intrusivemeans of exposing the heart for surgery will be developed and thismethod should in no way be read to limit its use to open chest cavities,or in the use of retractors.

Following the securing of the chest retractor, flex arm 191 with afinger 10 attached thereto (FIG. 10) is attached to the retractor in afix flex arm step 91. Next, finger 10 is placed about the area of theheart on which surgery is to be performed in a finger placement step 92.Then, the finger 10 is attached to the heart in a finger attachment step94 and in a make flex arm rigid step 95, the flex arm is made stiff,typically by tightening variable tension lock 195 (FIG. 10).

The fingers 10, 12 may be placed together on the heart in a singlefinger placement step 92 and then attached to the heart in a singlefinger attachment step 94, or each finger 10, 12 may be placed on theheart surface, and then attached to the heart surface independently ofeach other. In any event, the result is that the finger 10 lies on oneside of the surgical site, and a second finger 12 lies generally on theopposite side of the surgical site. Optionally, to achieve bettertraction in a following rotation step, and thus better isolation of theheart surface, the fingers 10, 12 may be gently pressed onto the heart(the fingers do not penetrate the heart surface).

Next, in a finger rotation step 96, at least one finger is rotated in adirection which increases the surface tension of the heart surfaceacross the surgical site until a desired tension is achieved across thesurgical site area. Once the desired tension is achieved on the heartsurface, the tension is maintained by locking the device in that currentstate of rotation in a position locking step 98. Yet even better heartsurface isolation may be achieved at this point by lifting the fingers10, 12 (and thus the isolated heart surface) slightly. Surgery may thenbe performed at the isolated surgical site on the heart as well as onany veins or arteries going to or from the surgical site. If necessary,during surgery, the handles may be rotated in either a gripping orreleasing direction to increase or decrease the tension at the surgicalsite. Then, after the surgery is completed, the above detailed steps maybe reversed and the device removed.

FIGS. 11-17 describe various examples and embodiments. For brevity andclarity, a description of those parts which are identical or similar tothose described in connection with other embodiments illustrated inFIGS. 1 through 10 will not be repeated. Reference should be made to theforegoing paragraphs with the following description to arrive at acomplete understanding of these embodiments. It is understood thatfeatures of various examples and embodiments may be interchanged,combined or otherwise reconfigured.

FIG. 11a is a side view of finger assembly 201. In FIG. 11a, finger 210is hidden from view by finger 212. Fingers 210 and 212 are similar tofingers 10 and 12 (FIG. 1), except that fingers 210 and 212 arecylindrically convex or have a convex cylindrical shape. “Cylindricallyconvex” means that the diameter of fingers 210 and 212 at end 202 isapproximately the same as the diameter at end 204, but the diameter offingers 210 and 212 gradually increases from end 202, at point B, to amaximum diameter at point A (FIG. 11a). Point A is approximately at thelongitudinal midpoint between end 202 and 204. The diameter of fingers210 and 212 at point A is typically twice the diameter of fingers 210and 212 at point B. However, the diameter of fingers 210 and 212 atpoint A could be any multiple of the diameter at point B. Thus, fingers210 and 212 can be said to be cylindrically convex.

FIG. 11b is an isometric drawing of finger assembly 201 showing fingers210 and 212 adjacent to the surgical site. In FIG. 11b, finger 210 isplaced on one side of the surgical site 206 and finger 212 is placed onthe other side of surgical site 206. In a method described previously inreference to an earlier embodiment, fingers 210 and 212 may be rotatedin a direction which increases the surface tension of the heart surfaceacross the surgical site. The direction and relative magnitude of thesurface tension after fingers 210 and 212 is rotated can be representedas arrows 220 through 238 in FIG. 11b. As can be seen in FIG. 11b,arrows 224 and 234, which are approximately at the longitudinal midpointof fingers 210 and 212, are significantly longer than arrows 220, 228,230, and 238 which represent the relative surface tension are at theends of fingers 210 and 212. Thus, the surface tension in the middle ofthe site is greater than at the edges. This increase in surface tensionat the center of the surgical site is due to the fact that a portion offinger 210 at the midpoint must travel a greater distance than theportion of finger 210 at ends 202 or 204 for the same amount of angularrotation.

This concept is illustrated in FIG. 11c, which is a front view of finger212. Point B is a point at end 202 on the outer circumference of finger212. Point A is also on the outer circumference of finger 212, but closeto the longitudinal midpoint of finger 212 (FIG. 11a). As illustrated inFIG. 11c, when finger 212 is rotated about its longitudinal axis throughan angle a, point B moves to point B′. Similarly, point A moves to A′.Point A moves more than point B. In fact, the greater the relativediameter of the circumferences, the greater the relative movementbetween point A and point B along their respective circumferences. Thisincrease in movement causes a corresponding increase in surface tension.Thus, the surgeon can increase the surface tension in the middle of thesurgical site (FIG. 11b).

FIG. 12a is a side view of finger assembly 201, however, in thisembodiment the finger elements are replaced with fingers 310 and 312. InFIG. 12a, finger 310 is hidden from view by finger 312. Fingers 310 and312 are similar to fingers 10 and 12, except that fingers 310 and 312are cylindrically concave or have a concave cylindrical shape.“Cylindrically concave” means that the diameter of fingers 310 and 312at end 302 is approximately the same as the diameter at end 304, but thediameter of fingers 310 and 312 gradually decreases from end 302, atpoint C, to a minimum diameter at point D. Point D is approximately atthe longitudinal midpoint between end 302 and 304. The diameter of thefingers at point C could be any multiple of the diameter at point D,depending on the amount of relative surface tension desired and thematerial used.

FIG. 12b is an isometric drawing of finger assembly 201 showing fingers310 and 312 adjacent to the surgical site. In FIG. 12b, finger 310 isplaced on one side of the surgical site 206 and finger 312 is placed onthe other side of surgical site 206. In a procedure similar to the onedescribed in the first embodiment, fingers 310 and 312 are be rotated ina direction which increases the surface tension of the heart surfaceacross the surgical site. The direction and relative magnitude of thesurface tension of the heart surface is represented in FIG. 12b asarrows 320 through 338. As can be seen in FIG. 12b, arrows 324 and 334,which are approximately at the longitudinal midpoint of fingers 310 and312, are significantly shorter than arrows 320, 328, 330, and 338 whichrepresent the surface tension at the ends of fingers 310 and 312. Thisdecrease in surface tension at the center is due to fact that theportion of finger 310 at the longitudinal midpoint travels a shorterdistance than the portion at ends 302 or 304 for the same amount ofangular rotation. The surgeon, therefore, can thus decrease the surfacetension in the middle of the surgical site relative to the outside areaof the surgical site.

FIG. 13a is a side view of a finger assembly, however, in thisembodiment the finger elements are replaced with fingers 410 and 412.Fingers 410 and 412 have a camber on one side to form a cam shapedcross-section. Fingers 410 and 412 are cylindrically cam-shaped, whichmeans that the diameter of fingers 410 and 412 at end 402 isapproximately the same as the diameter at end 404, but the diameter offingers 410 and 412 gradually increases eccentrically from end 402, atpoint E, to a maximum diameter at point F. Point F is approximately atthe longitudinal midpoint between end 402 and 404.

FIG. 13b is a front view of finger 412. In this view, end 402 is shownas circle 406. Outline 408 represents the cross-sectional outline offinger 412 at approximately point F (FIG. 13a). As illustrated in FIG.13b, the cross-sectional shape of finger 412 is that of an eccentriccam.

This embodiment allows the amount of surface tension to be vary,depending on the circumstances and the surgeon's preferences. If thesurgeon feels that greater tension across the middle of surgical site isimportant, the surgeon can position fingers 410 and 412 with camber side414 down facing the heart's surface. On the other hand, if the surgeondesires a more uniform amount of tension across the entire surgicalsite, the surgeon can keep camber side 414 up, away from the heart.

As explained previously, there are several disadvantages associated withusing suction to isolate a surgical site. Regardless of thedisadvantages, many surgeons may prefer to use suction to stabilize theheart. One of the primary disadvantages with using suction is that thehorizontal surface tension of the heart must be maintained by a verticalsuction force. As explained previously, there are disadvantages withusing only a vertical suction force maintain a horizontal surfacetension.

This embodiment overcomes many of the limitations of the prior artbecause it addition to the vertical suction force, this embodiment alsoincreases the surface tension by using a horizontal rotating force.

Turning now to FIG. 14a, which is a side view of an embodiment whichuses suction to attach the finger elements to the surface of the heart.Because this is a side view, finger 1410 is hidden from view by finger1412. In this embodiment, finger 1412 is partially surrounded by acylindrical cover 1418.

FIG. 14b is an exploded view of FIG. 14a. Finger 1412 is a hollowcylinder which has a plurality of longitudinal slits 1414 around itsperimeter. Finger 1412 also has attachable portion 1434 which, similarto the first embodiment, fits securely in cylinder 1444 of the handle1415. However, in this embodiment attachable portion 1434 is hollow andhas connection 1420 at one end. Vacuum tube 1422 fits tightly overconnection 1420 such that a hermetic seal is created between vacuum tube1422 and connection 1420. Similar to previous embodiments, sleeve 20fits over cylinder 1444 and is restrained by O-ring 24.

FIG. 14c is a section view through fingers 1410 and 1412. Fingers 1410and 1412 have hollow cylindrical openings 1426 and 1428 runninglongitudinally through their respective centers. Slits 1414 form aplurality of ribs 1416 and 1417 within the perimeter walls of fingers1410 and 1412. Of course, slits 1414 could be a variety of shapes. Alsoshown in FIG. 14c, are covers 1418 and 1419 which partially surroundsfingers 1410 and 1412. Each of covers 1418 and 1419 have a single largeslit 1423 and 1424. Fingers 1410 and 1412 rotate within and relative tocovers 1418 and 1419.

FIG. 14d is a section view of fingers 1410 & 1412 adjacent to thesurface of a heart. In operation, a vacuum pump or source (not shown) isattached to vacuum tube 1422 (FIG. 14b) which creates a low pressure orsuction in vacuum tube 1422. This low pressure is transferred throughthe hollow portion of attachment portion 1434 to cylindrical openings1426 and 1428. The low pressure causes a suction force in slits 1414which allow fingers 1410 and 1412 to attach to heart surface 1430through suction as shown in FIG. 14d. Finger 1410 can then be rotatedwith respect to finger 1412 and vice versa. This rotation causes ahorizontal surface tension or stretching in the direction represented byarrows 1433 and 1432, and thus the surgical site can be stabilized by alateral force—not a vertical force as in the prior art.

Various clinging accessories may be used to attach fingers 10, 12, 210,212, 310, 312, 410, and 412 to the surface tissue of the heart. Theclinging accessory previously shown uses plurality of tines 30 in FIGS.1-4, 7-8, 11-13. As previously discussed, tines 30 are only one form ofa variety of clinging accessories that could be used with any form ofthe previous embodiments. Other clinging accessories (such as suctionholes, suction cups, rough textured surfaces (such as sandpaper), barbs,or electrostatic attachment, for example) may be used with anyembodiment. It is understood that as fingers are gently pressed againstthe heart, they do not penetrate the heart surface but instead engagethe surface in a manner that enables manipulation of tissue withouttissue damage.

Nylon or other forms of plastic tines, for instance, may be lesstraumatic to the heart tissue than the use of stainless steel ortungsten carbide tines. FIG. 15a is a front view of an embodiment of afinger assembly with the fingers 10 and 12 (FIG. 2), however finger 10is surrounded by a plurality of nylon hooks 1502 and finger 12 issurround by a plurality of nylon hooks 1504, hooks 1502 and 1504 aresimilar to that used in a Velcro™ fastening system. Hooks 1502 and 1504are approximately 0.050 inches in length. Hooks 1502 and 1504 aredesigned to minimize heart surface engagement. The hooks are of astiffness so that should a stretching rotation require the releasing ofthe tines from the heart surface, they may release without ripping theheart surface, and then engage the heart surface at a new location, ifnecessary. Also, it should be noted that the tines point generally inthe direction of the grabbing rotation.

Another embodiment of clinging accessory is illustrated in FIG. 15b,which employs a plurality of straight nylon tines or bristles 1508surrounding finger 12 and nylon bristles 1506 surrounding finger 10.Bristles 1506 and 1508 gently engage into the heart tissue. Of course,bristles 1506 could also be made out of any type of plastic or stainlesssteel.

FIG. 15c is a front view of fingers 10 and 12 where the finger elementsare surrounded by a plurality of nylon tines or bristles 1510 and 1512,respectively. In this embodiment, bristles 1510 and 1512 have tiny ballsor spheres 1515 at the protruding end of the bristles. The diameter ofthe balls are larger than the diameter of the bristles. These differentembodiments have unique advantages and disadvantages and offer thesurgeon more choices based on personal preferences. For instance,bristles 1508 and 1506 offer better traction than bristles 1510 and1512. However, bristles 1510 and 1512 reduce trauma to the heart tissue.

FIG. 15d is a cross section view of fingers 10 and 12 adjacent to hearttissue 1520. In this embodiment, a plurality of straight nylon bristles1516 and 1514 are used as the clinging accessory, however bristles 1516and 1514 use bristles of a progressively different degree of length. Asillustrated in FIG. 15d, bristles 1516 and 1514 are longer on the topside of fingers 10 and 12 than the bristles on the bottom side. Thelength of each radial row of bristles vary according to the radial orangular position of each row at the perimeter of the surface of thefinger. As shown in FIG. 15d, the shorter bristles are pointed towardsheart tissue 1520. Similarly, FIG. 15e is a cross section view offingers 10 and 12 adjacent to fat tissue 1522 and heart tissue 1520. Inthis figure, the longer bristles of bristles 1516 and 1514 pointed downtowards the heart tissue. This embodiment provides the surgeon with theoption of varying the degree of engagement into the heart or fat tissue.

Depending on the condition and location of the surgical site, hearttissue 1520 may be surround by fat tissue 1522 (FIG. 15e). On the otherhand, if little or no fat tissue surrounds the surgical site, thesurgeon can simple rotate fingers 10 and 12 so that the shorter bristlesare adjacent to heart tissue 1520, as illustrated in FIG. 15d.

As discussed previously, the finger elements use clinging accessories to“grab” the tissue of the heart. The clinging accessories can be hooks,tines, bristles or other rough surfaces. These clinging accessories maytend to catch and snag sutures used by surgeons during the procedure. Toavoid snagging of sutures, gloves, and transplanted arteries, a sutureguard may be positioned over the finger elements. Such a device isillustrated in FIG. 16a.

FIG. 16a is an isometric view looking down upon finger assembly 36 as itis attached to suture guard 1602. FIG. 16b is an exploded isometric viewof FIG. 16a showing how suture guard 1602 fits between sleeve 20 and 22.Suture guard 1602 can be made of metal, plastic or any other acceptablematerial. Plastic is the preferred embodiment because it can be moldedinto intricate shapes easily, is lightweight, and it can be clear. Usingclear plastic allows the surgeon to see through suture guard 1602, whichallows the surgeon to see as much of the surgical site as possible. FIG.16c is an isometric view looking up at the bottom of finger assembly 36when it is attached to suture guard 1602. FIG. 16d is an exploded viewof FIG. 16c.

Turning now to FIG. 16d, the suture guard 1602 has fins 1604 through1609 which are shaped to press against the outside perimeter surface ofthe sleeves 20 and 22. This dual pressure against the sleeves 20 and 22restrains the suture guard 1602 and prevents the suture guard 1602 fromslipping off the sleeves 20 and 22. The suture guard 1602 also has aplurality of elements or legs 1612 and 1614, which cantilever overfingers 10 and 12 to protect any sutures from tines 30. The legs 1612and 1614 are generally parallel or longitudinally aligned with thefingers 10 and 12. In this embodiment, the legs 1612 and 1614 have across-sectional shape of an arc. An arc cross-sectional shape allows thelegs to closely follow the contours of the fingers 12 and 10 whileminimizing any visual obstruction to the surgical site. The legs 1612and 1614 are attached and supported by the fins 1608 and 1609 which areattached to a connecting member 1610. Connecting member 1610 connectsthe fins 1608, 1606, and 1604, and thus, distributes and transfers anyforce from the cantilevered die-legs 1612 and 1614 to the fins 1606 and1604.

FIG. 17a is an isometric drawing of finger assembly 36 attached to anembodiment of the suture guard with a blower. In this embodiment, sutureguard 1702 has spray tubes 1704 and 1706 along the inside edge of thelegs 1712 and 1714. The spray tubes 1704 and 1706 have a plurality ofopenings or nozzles 1708. The spray tubes 1704 and 1706 may beindependent of legs 1712 or 1714 or they may be molded together, andthus become integral with legs 1712 and 1714. In another embodiment, thelegs 1712 and 1714 could simply be hollow and have a plurality ofnozzles along the inside edge.

Spray tubes 1704 and 1706 are hermetically joined with y-connection 1710to pressure tube 1718. Pressure tube 1718 is a flexible plastic orrubber tube capable of delivering a pressurized fluid from a supply ofsaline solution, water, air and/or carbon dioxide (FIG. 17b) to spraytubes 1704 and 1706. The pressurized fluid exits through nozzles 1708.Nozzles 1708 are positioned, or “aimed” at the surgical site such thatwhen a fluid flows through them, a plurality of sprays are created whichwashes the surgical site.

FIG. 17b is a combination top view and schematic view of suture guard1702 attached to finger assembly 36. Finger assembly 36 is mounted on aflexible arm assembly 190, which includes a universal retractor mounting194 and variable tension lock 195. As discussed previously, universalretractor mounting 194 mounts to chest retractor 110 (FIG. 1a).Pressured tube 1718 is shown running alongside of flexible arm assembly190. It is important to note, that in another embodiment, pressured tube1718 could also be incorporated into flexible arm assembly 190.Attachment connection 1716 is either attached to or integral withuniversal retractor mounting 194. Attachment connection 1716 connectspressurized tube 1718 with attachment tube 1719. Attachment tube 1719 isconnected to water/air supply 1724. Between water/air supply 1724 andattachment connection 1716 is stop lock 1722 and metering valve 1720,all fluidly connected via attachment tube 1719.

Water/air supply 1724, known in the art, can be a saline bag combinedwith a gas source, such as carbon dioxide or air. The gas in the sourceis kept under pressure. Furthermore, there is a certain amount of headpressure in the saline if the saline is hangs above the surgical site.This combined pressure causes the fluid, which is a combination of gasand saline to flow through attachment tube 1719. Stop lock 1722 cuts offthe fluid in the event that metering valve 1720 cannot control the flowof fluid through attachment tube 1719. Under normal circumstances,however, metering valve 1720 controls the flow of fluid throughpressured tube 1718, and ultimately, to nozzles 1708 (FIG. 17a).Metering valve 1720 is a roller clamp valve and is well known in theart.

The fluid continues to move through attachment tube 1719 to pressuredtube 1718. Pressured tube 1718 joins spray tubes 1704 and 1706 andv-connector 1710 (FIG. 17a). As previously discussed, the fluid thenmoves through spray tubes 1704 and 1706, out nozzles 1708 in the form ofa fine spray (FIG. 17a). The fine spray washes the surgical site.

Though the invention has been described with respect to a specificpreferred embodiment, many variations and modifications will becomeapparent to those skilled in the art upon reading the presentapplication. It is therefore the intention that the appended claims beinterpreted as broadly as possible in view of the prior art to includeall such variations and modifications.

What is claimed is:
 1. A device for isolating a cardiac surgical site,comprising: a first and second finger, each finger having a clingingaccessory adapted to attach to a heart, wherein at least one of thefingers may rotate on a surface of the heart such that the rotationstretches a surgical site, and at least one of the fingers has a varyingdiameter; and a link coupling the first finger to the second finger, anda stabilizing member coupling to the link, wherein the link comprises: aball disposed between the first finger and the second finger adapted tosecure an attachment to the stabilizing member; a first attachment barcoupled between the first finger and the ball; and a second attachmentbar coupled between the second finger and the ball.
 2. The device ofclaim 1, wherein the clinging accessory comprises a plurality of tines,each tine having a distal end and proximal end such that the proximalend is coupled to a surface of the finger.
 3. The device of claim 2,wherein the distal end is hook shaped.
 4. The device of claim 2 whereinthe tines are straight.
 5. The device of claim 2 wherein the distal endhas an enlarged spherical head.
 6. The device of claim 1, furthercomprising a guard coupled to the first finger and the second finger,wherein the guard has at least one element, and wherein the element islongitudinally aligned with at least one finger such that the elementpartially covers the finger.
 7. The device of claim 6, furthercomprising a spray tube coupled to the guard, wherein the spray tubecomprises at least one spray nozzle positioned and directed so thatfluids may be sprayed onto a surgical site.
 8. The device of claim 7,further comprising a fluid supply controller coupled to the spray tubeto regulate a flow of fluids.
 9. A device for isolating a cardiacsurgical site, comprising: first and second finger, each finger having aclinging accessory adapted to attach to a heart, wherein at least one ofthe fingers may rotate on a surface of the heart such that the rotationstretches a surgical site; a guard coupled to the first finger and thesecond finger; and a link coupling the first finger to the secondfinger, and a stabilizing member coupling to the link, wherein the linkcomprises: a ball disposed between the first finger and the secondfinger adapted to secure an attachment to the stabilizing member; afirst attachment bar coupled between the first finger and the ball; anda second attachment bar coupled between the second finger and the ball.10. The device of claim 9, wherein the stabilizing member comprises: asocket for coupling with the link; a flexible arm with a first end and asecond end wherein the first end couples to the socket; a tighteningdevice coupled to the flexible arm for fixing the position of theflexible arm; and a mounting device coupled to the second end of theflexible arm.
 11. The device of claim 9, wherein the guard has at leastone element, and wherein the element is longitudinally aligned with atleast one finger such that the element partially covers the finger. 12.The device of claim 11, wherein the element has a cross-sectional shapein the form of an arc.
 13. The device of claim 11, wherein the guardfurther comprises a support coupled to at least one element such that atleast one element is supported above the respective finger.
 14. Thedevice of claim 9, further comprising a spray tube coupled to the guard,wherein the spray tube comprises at least one spray nozzle positionedand directed so that fluids may be sprayed onto a surgical site.
 15. Thedevice of claim 14, further comprising a fluid supply controller coupledto the spray tube to regulate a flow of fluids.
 16. The device of claim15, further comprising a supply of fluids coupled to the fluid supplycontroller, wherein the fluids comprise saline solution.
 17. The deviceof claim 15, further comprising a supply of fluids coupled to the fluidsupply controller, wherein the fluids comprise water.
 18. The device ofclaim 15, further comprising a supply of fluids coupled to the fluidsupply controller, wherein the fluids comprise carbon dioxide.
 19. Thedevice of claim 15, further comprising a supply of fluids coupled to thefluid supply controller, wherein the fluids comprise air.
 20. A devicefor isolating a cardiac surgical site, comprising: a first and secondfinger, each finger having a clinging accessory adapted to attach to aheart, wherein at least one of the fingers may rotate on a surface ofthe heart such that the rotation stretches a surgical site, and at leastone of the fingers has a varying diameter; and a guard coupled to thefirst finger and the second finger.
 21. The device of claim 20, whereinthe guard comprises an element, and wherein the element islongitudinally aligned with at least one finger such that the elementpartially covers the finger.
 22. The device of claim 21, wherein theelement has a cross-sectional shape in the form of an arc.
 23. Thedevice of claim 20, further comprising a spray tube coupled to theguard, wherein the spray tube comprises at least one spray nozzlepositioned and directed so that fluids may be sprayed onto a surgicalsite.
 24. The device of claim 20, further comprising a fluid supplycontroller coupled to the spray tube to regulate a flow of fluids. 25.The device of claim comprising a supply of fluids coupled to the fluidsupply controller, wherein the supply saline solution.
 26. The device ofclaim 24, comprising a supply of fluids coupled to the fluid supplycontroller, wherein the supply of fluids comprises water.
 27. The deviceof claim 24, further comprising a supply of fluids coupled to the fluidsupply controller, wherein the supply of fluids comprises air.